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  1. 1. LOGO SPECT Imaging Single-Photon Emission Computed Tomography
  2. 2. LOGO Group 4 Christopher Emerson Caterina Pette Douglas Wright
  3. 3. LOGO Contents Advantages / Disadvantages Medical / Non-Medical Applications History Modern Systems Pricing U.S. SPECT Statistics
  4. 4. LOGO Advantages Provides Physiological Information though Functional Imaging Metabolic Activity Blood Flow Intrinsic Lesion Localization though Radiopharmaceutical Use Radio-labeled ligans migrate to specific imaging site 3-D Imaging Hybrid Imaging Systems provide Increased Spatial Resolution SPECT/CT http://xa.yimg.com/kq/groups/15914941/74581872/name/EJNMMI-SPECT%25EF%2580%25A2CT-Review.pdf, “Advantages and disadvantages of PET and SPECT in a busy clinical practice” Timothy M. Bateman, MD
  5. 5. LOGO Disadvantages Gamma Emissions Harmful due to Ionization Potential Non-Hybrid Devices have Poor Spatial Resolution Tissue boundaries are ill-determined Long Scan Time Upwards of 30-40 minutes Inconveniences certain patient populations Use of Possible Allergens Radiopharmaceuticals could induce allergic reactions Intrinsic Reliance on Radiopharmaceuticals Severe supply shortages can halt imaging http://www.massgeneral.org/imaging/services/procedure.aspx?id=2255 http://blue.regence.com/trgmedpol/radiology/rad44.html
  6. 6. LOGO Medical Applications Myocardial Perfusion Imaging Brain Perfusion Thyroid Function Renal Function Bone Imaging Myocardial Perfusion Imaging
  7. 7. LOGO Myocardial Perfusion Imaging Assessment of hemodynamic consequences of Coronary Artery Disease Allows for risk stratification and pre- surgical guidance Determines ischemic myocardial tissue though rest and stress cardiac studies Myocardial Perfusion Scan Stress Rest http://eradiology.bidmc.harvard.edu/LearningLab/cardio/Furie.pdf
  8. 8. LOGO Brain Perfusion Pre-surgical localization of epileptic seizure origin Technetium-99m labeled ECD or HMPAO injected at time of seizure Localize to region of increased blood flow Images during and after seizure are compared to identify seizure origin http://my.clevelandclinic.org/Documents/Epilepsy_Center/PET%20and%20SPECT%20-%20Wu.pdf
  9. 9. LOGO Thyroid Function Thyroid tumor causes increased metabolic activity Localization achieved through the use of Iodine-123 and Iodine-131 Iodine-123: Routine testing for hyperthyroidism and nodules Iodine-131: Whole-body imaging for detection of metastasis SPECT-CT shows metastasis is localized in tip of transverse process of the sixth thoracic vertebra A. Whole-body SPECT B. Diagnostic CT C. Fusion Image http://www.ncbi.nlm.nih.gov/pubmed/1418597
  10. 10. LOGO Renal Function Renal lesions can result in elevated levels of norepinehprine, epinephrine, dopamine, cathecholamines, and VMA Localization achieved through the use of Indium-111 Pentetreotide SPECT scans revealed large right suprarenal lesion http://www.med.harvard.edu/JPNM/TF00_01/Sept19/WriteUp.html
  11. 11. LOGO Bone Imaging Early Detection of Osteonecrosis of the Femoral Head http://jnm.snmjournals.org/content/43/8/1006/F1.expansion.html A. Whole-body scintigraphy B. Bone SPECT C. MRI Scan A B show “cold” areas in both femoral heads while C shows normal findings
  12. 12. LOGO Small Animal SPECT SPECT/CT Imaging Used to determine drug efficacy in pre-clinical trials http://jnm.snmjournals.org/content/49/10/1651/F5.expansion.html
  13. 13. LOGO Non-Medical Applications Detection of nuclear waste Gamma cameras used to study the environmental behavior of nuclear waste Helps scientists monitor and control the spread of radioactivity Fe(III)-reducing bacteria immobilizes technetium in sediment http://www.bloomberg.com/news/2011-08-02/tepco-reports-second-deadly-radiation-reading-at-fukushima-plant.html
  14. 14. LOGO Non-Medical Applications (cont.) Detection of nuclear emission Fukushima Nuclear Power Plant Gamma cameras can be used to image radiation readings of wrecked nuclear power plant A photograph shows a gamma camera image of an area around the main exhaust of Tokyo’s nuclear power plant detecting 5 Svt/hr. http://www.bloomberg.com/news/2011-08-02/tepco-reports-second-deadly-radiation-reading-at-fukushima-plant.html Tokyo Electric Power Co.'s (Tepco) Fukushima Dai-Ichi nuclear power station in Fukushima, Japan, on Monday, Aug. 1, 2011. Soil Sampling
  15. 15. LOGO History 1950s 1950s – 1960s 1960s – 1970s 1970s Why the Delay?
  16. 16. LOGO 1950s 1896 – Antoine-Henri Becquerel discovers Radioactivity Discovered that radiation from Uranium did not need any excitation from an external energy source to emit radiation. 1934 – Frederic and Irene Joliot-Curie produce first artificial radionuclide Positron-emitting radionuclide of phosphorous http://www.brainmattersinc.com/forphysicians/historyofspect.html Antoine-Henri Becquerel Irene Curie and Frederic Joliot http://www.rtstudents.com/radiology/history-of-radiology.htm
  17. 17. LOGO 1950s 1943 – Gyorgy Hevesy develops radioactive tracers Used to study the metabolic processes in plants and animals 1946 – Oak Ridge National Laboratory began production of radionuclides for medical use http://www.brainmattersinc.com/forphysicians/historyofspect.html Gyorgy Hevesy Oak Ridge National Laboratory http://www.rtstudents.com/radiology/history-of-radiology.htm
  18. 18. LOGO 1950s – 1960s 1950 – Benedict Cassen assembled the first automated scanning system Motor-driven scintillation detector coupled to a printer 1957 – Hal Oscar Anger develops Anger Camera Sodium-Iodine scintillation crystal Vacuum tube photomultipliers http://jnm.snmjournals.org/content/12/8/573.full.pdf http://www.ncbi.nlm.nih.gov/pubmed/11155815 Benedict Cassen Hal Oscar Anger
  19. 19. LOGO 1960s – 1970s Development of generator system to produce Technetium-99m Most utilized element in Nuclear Medicine Employed in a wide variety of Nuclear Medicine studies Late 1963 – David E. Kuhl and Roy Q. Edwards introduce emission and transmission tomography Later developed into Single Photon Emission Computed Tomography (SPECT) Used 32 photon detectors Images were frequently distorted and not of diagnostic quality http://www.news-medical.net/health/History-of-Nuclear-Medicine.aspx http://www.uclimaging.be/ecampus/etu_med/option_2011/opt_2011_3120_mn.pdf David Edmund Kuhl
  20. 20. LOGO 1970s Late 1970s – Most organs of the body could be visualized with nuclear medicine procedures Liver, spleen, brain tumor localization, and gastrointestinal tract 1980s – Radiopharmaceuticals were designed for diagnosing heart disease and cancer 1980s – Development of Monoclonal Antibodies Act as cell-specific ligans that, when tagged with a radioisotope, localize to a specific region of the body Can detect cancerous cells before anatomical changes occur http://interactive.snm.org/index.cfm?PageID=1107 http://www.news-medical.net/health/History-of-Nuclear-Medicine.aspx
  21. 21. LOGO Radionuclide Specificity www.themegallery.com
  22. 22. LOGO Why the Delay? The development of SPECT was slow due to a number of factors: Image analysis algorithms were not advanced enough Limited number of radionuclides available as tracers Device size limited SPECT use outside of hospitals Physicians were inexperienced reading SPECT images Better late than never! Advances in mathematics, innovations in radionuclide and ligand development, and the advent of multi-modality imaging systems laid the foundation for modern SPECT and SPECT/CT devices http://www.imagingeconomics.com/issues/articles/MI_2004-06_02.asp I wonder what they exSPECT me to see from this…
  23. 23. LOGO Modern Systems Leading Device Manufacturers Brivo NM 615 Discovery NM 630 Discovery NM/CT 670 Ventri Discovery NM 750b
  24. 24. LOGO Leading Device Manufacturers GE Healthcare Siemens Healthcare Philips Healthcare Toshiba Medical Systems
  25. 25. LOGO Brivo NM 615 Single-Headed System Thin, Pivoting Gantry 5.12 m x 3.74 m x 2.30 m 500 lb Patient Limit Increases patient population Upright, chair, or stretcher imaging Increases patient comfort Elite NXT Detectors Exceptionally High Count Rate 460k counts-per-second SPECT-Optimized Collimators Dose management Reduce time or dose by 50% Acquisition time rivals dual-headed systems Auto-Body Contouring Infra-red detectors minimize the distance between the patient and the detectors Xeleris 3 Workstation http://www3.gehealthcare.com/en/Products/Categories/Nuclear_Medicine/General_Purpose_Cameras/Brivo_NM615 http://www.gehealthcare.com/euru/clinical-education/images/december_newsletter/xeleris_3_460x260.jpg
  26. 26. LOGO Brivo NM 615 http://www3.gehealthcare.com/~/media/Downloads/Product/Product-Categories/Nuclear-Medicine/General-Purpose-Scanners/Brivo- NM615/GEHealthcare-Brochure_Brivo-NM-615.pdf?Parent={83A02FFC-6F7B-48B3-AB0F-AC550678E0B0}
  27. 27. LOGO Discovery NM 630 http://www3.gehealthcare.com/en/Products/Categories/Nuclear_Medicine/General_Purpose_Cameras/Discovery_NM_630 Upgrade from Brivo NM 615 Dual-Headed System Cut imaging time or dose in half, again. 180°or 90°Orientations
  28. 28. LOGO Discovery NM/CT 670 Upgrade from Discovery NM 630 IQ Enhance Faster pitch helical scanning Coverage equivalent to 50 slice CT scans with same imaging speed 16-minute bone protocol BrightSpeed Elite CT Technology Lower dose but maintained quality http://www3.gehealthcare.com/en/Products/Categories/Nuclear_Medicine/SPECT-CT_Cameras/Discovery_NM-CT_670
  29. 29. LOGO Discovery NM/CT 670 http://www3.gehealthcare.com/~/media/Downloads/Product/Product-Categories/Nuclear-Medicine/SPECT- CT%20Scanners/GEHC-Brochure_%20Discovery_NM-CT-670.pdf?Parent={B5FEFEC2-711D-444A-AB1E-87EA682FB27C}
  30. 30. LOGO Ventri Originally Designed for Cardiac Imaging Restricted Imaging Range Now offers Neurological Imaging Smaller Office Footprint Less expensive Similar Technology as Larger Devices http://www3.gehealthcare.com/en/Products/Categories/Nuclear_Medicine/Cardiac_Cameras/Ventri
  31. 31. LOGO Ventri http://www3.gehealthcare.com/en/Products/Categories/Nuclear_Medicine/Xeleris_3/Evolution_for_Cardiac
  32. 32. LOGO Discovery NM 750b Dedicated Breast Imaging Solid-state Cadmium Zinc Telluride Detectors 3 times the imaging sensitivity of conventional NaI gamma cameras Degradation-free Uniformity across entire Field-of-View Overcomes Breast Density challenges Single or Dual-Head Configuration MLO = Mediolateral Oblique View CC = Cranio – Caudal View http://www3.gehealthcare.com/en/Products/Categories/Nuclear_Medicine/Discovery_NM-CT_750b
  33. 33. LOGO Pricing Total Price Device Imaging Influential Circumstances
  34. 34. LOGO Imaging Base Imaging Cost Radiopharmaceuticals Used Interpretation by Radiologist Organ Price Bone Imaging Scan: $585.20 Radiopharmaceutical: $62.35 Liver / Spleen Imaging Scan: $993.30 Radiopharmaceutical: $77.90 Brain Imaging Scan: $809.75 Renal Imaging Scan: $996.08 Joint Imaging Scan: $1016.00 Myocardial Perfusion Imaging Scan: $2902.00 http://outofpocket.com/OOP/Default.aspx?q=SPECTcx=015166729515697606531%3a3sy7u0rpz2ocof=FORID%3a9
  35. 35. LOGO Device Device Cost Multi-Headed, New : $400,000 Multi-Headed, Refurbished: $100,000 Utility Costs Powering the Device and Control Station Powering the Electronics in the Imaging Suite Wages of Employees Radiology Technicians Maintenance Personnel Sanitation Personnel Hardware Updates Software Updates http://www.ibh.com/SPECT-ComplexCases.pdf
  36. 36. LOGO Influential Circumstances Age of Imaging System Recently Purchased Hospital may charge more till it breaks even Post Breaking-Even Hospital may charge less since device has “paid-for-itself” Neighboring Hospital Competition Rich Competition May charge less to attract more customers Poor Competition May charge more to capitalize on pseudo- monopoly Pending Lawsuits
  37. 37. LOGO U.S. SPECT Statistics Imaging Locations and Frequency Installed Devices and Patient Waiting Times Projected Purchases
  38. 38. LOGO Imaging Locations and Frequency ~ 17 million Nuclear Medicine procedures performed at 7,230 different sites in 2010 Procedure frequency decreased by 0.5% each year from 2007 to 2010 87% of procedures conducted in nonhospital locations are cardiovascular studies 47% of procedures conducted in hospital locations are cardiovascular studies More likely to be conducting other procedures including bone scans, liver, renal, respiratory, infection/abscess, and tumor localization studies. 1/3 of Nuclear Imaging sites are physician office locations Includes cardiology offices, multispecialty clinics, and imaging centers ~ 25% of imaging sites provide neurology applications Projected to grow to 1/3 of sites by 2013 Driven by development of radiopharmaceuticals to address Parkinson's disease http://www.auntminnie.com/index.aspx?sec=vdpsub=defpag=disitemId=96830
  39. 39. LOGO Installed Devices and Patient Waiting Times Dual-head SPECT installations comprise 64% of the gamma camera installed base Down from 70% in 2008 SPECT/CT camera installed base increased from 2% of the installed base in 2008 to 9% in 2011 69% of the SPECT/CT and SPECT camera installed base are considered to be general purpose 31% are dedicated cardiac cameras Patient waiting times for nuclear imaging procedures have decreased Waiting times of 1+ days for scheduled outpatient procedures decreased from 77% of the sites in 2003 to 43% of the sites in 2011 http://www.auntminnie.com/index.aspx?sec=vdpsub=defpag=disitemId=96830
  40. 40. LOGO Projected Purchases Estimated replacement time of 12.8 years for a typical gamma camera 85% of purchases are replacements 1 in 6 planned camera purchases through 2013 will be from physician offices ~ 50% are Dual-head SPECT cameras 33.33% are SPECT/CT systems Gaining momentum http://www.auntminnie.com/index.aspx?sec=vdpsub=defpag=disitemId=96830
  41. 41. LOGO